School-age adopted children's early responses to remote schooling during COVID-19

OBJECTIVE

This mixed-methods exploratory study sought to address the experiences of 89 adoptive parents (heterosexual, lesbian, and gay) in the United States with school-age children in relation to the transition to remote schooling and their children's mental health during the early part of the COVID-19 pandemic.

BACKGROUND

The transition to remote schooling and associated confinement during the COVID-19 pandemic presents challenges for families, particularly when children are struggling with mental health and learning challenges.

METHODS

Data were collected via an online survey between May and June 2020. Before the pandemic, almost half of the children received special education services.

RESULTS

Findings revealed that although a minority of children were doing well with remote schooling, the majority were struggling due to lack of motivation and an inability to work independently. Some parents voiced challenges with teacher communication and inconsistencies across classes and were overwhelmed by the demands of their new role as proctor/teacher. Some were dissatisfied with how children's school services had been implemented and noted difficulties with the online format of various services (e.g., therapy was less engaging). Regarding children's mental health, half of parents said it had stayed the same, one third said it had worsened, and the remainder said it had improved. The mental health of children adopted via foster care seemed to have benefited from the additional time spent at home. Yet most children were described as struggling in part due to social isolation and loss of routine, which manifested in a variety of ways, including anxiety, schoolwork avoidance, and boundary testing. Most parents tried to show patience, tolerance, and reassurance, but more than one third reported stress and frustration associated with not knowing how to best support their children.

CONCLUSION

The transition to remote schooling during COVID-19 may be especially challenging for adoptive families and other families whose children have higher levels of need.

IMPLICATIONS

Findings have implications for parents, teachers, school social workers and psychologists, and other professionals who work with children and families.

Oral and Written Language Abilities of School-Age Internationally Adopted Children from Eastern Europe

PURPOSE

Children adopted from Eastern Europe were assessed at ages 6 to 7 years and results were compared to the same children when they were 8 years. Patterns of relative strengths and weaknesses in language, verbal memory and literacy were analyzed. Variables that predicted reading and writing were determined.

METHOD

Children adopted from Eastern Europe between 1;0 and 4;11 years of age were assessed at ages 6 to 7 years and age 8 years on a variety of tests that measured language, verbal memory and literacy. Results were compared across ages, and language, verbal memory and literacy domains.

RESULTS

Group means for all measures fell within the average range at both ages. The children's scores were not significantly different from test norms except for measures of rapid naming and number repetition. However, a larger than expected percentage of children scored -1SD below the mean on decontextualized measures of verbal working memory and reading fluency. At age 8 years 24% of children received speech language therapy services and 26% had repeated a grade level. Vocabulary, expressive syntax, verbal short-term memory and writing were areas of relative strength. Higher level vocabulary knowledge was strongly correlated with all literacy measures.

CONCLUSION

As a group, Eastern European adoptees scored average on measures of language and literacy at 6 or 7 years and again at age 8 years. However, 26% of the children had repeated a grade and 24% were still receiving speech and language services. Vocabulary was an area of strength reflecting the children's enriched adopted home environments. In-depth knowledge of vocabulary was the best predictor of reading and writing. Some aspects of working memory were a strength but others were not. Rapid naming was also a weakness.

Psychosocial deprivation and receptive language ability: a two-sample study

Background

The quality of early caregiving experiences is a known contributor to the quality of the language experiences young children receive. What is unknown is whether, and if so, how psychosocial deprivation early in life is associated with long-lasting receptive language outcomes.

Methods

Two prospective longitudinal studies examining early psychosocial deprivation/neglect in different contexts (i.e., deprivation due to institutional care or deprivation experienced by children residing within US families) and receptive language as assessed via the Peabody Picture Vocabulary Test (PPVT) were used to assess the magnitude of these associations. First, 129 participants from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care in Romania, completed a receptive language assessment at age 18 years. Second, from the USA, 3342 participants from the Fragile Families and Child Wellbeing Study were assessed from infancy until middle childhood.

Results

Children exposed to early institutional care, on average, had lower receptive language scores than their never institutionalized counterparts in late adolescence. While randomization to an early foster care intervention had no long-lasting association with PPVT scores, the duration of childhood exposure to institutional care was negatively associated with receptive language. Psychosocial deprivation in US families was also negatively associated with receptive language longitudinally, and this association remained statistically significant even after accounting for measures of socioeconomic status.

Conclusion

Experiences of psychosocial deprivation may have long-lasting consequences for receptive language ability, extending to age 18 years. Psychosocial deprivation is an important prospective predictor of poorer receptive language.

Trial registration

Bucharest Early Intervention Project ClinicalTrials.gov Identifier: NCT00747396

Language Outcomes in Adults with a History of Institutionalization: Behavioral and Neurophysiological Characterization

Impoverished early care environments are associated with developmental deficits in children raised in institutional settings. Despite the accumulation of evidence regarding deficits in general cognitive functioning in this population, less is known about the impact of institutionalization on language development at the level of brain and behavior. We examined language outcomes in young adults and adolescents raised in institutions (n = 23) as compared to their socioeconomic status and age peers raised in biological families (n = 24) using a behavioral language assessment and linguistic event-related potentials (ERPs). Controlling for intelligence, adults with a history of institutionalization demonstrated deficits in lexical and grammatical development and spelling. Analyses of ERP data revealed significant group differences in the dynamic processing of linguistic stimuli. Adults with a history of institutionalization displayed reduced neural sensitivity to violations of word expectancy, leading to reduced condition effects for temporo-spatial factors that tentatively corresponded to the N200, P300/N400, and phonological mismatch negativity. The results suggest that language is a vulnerable domain in adults with a history of institutionalization, the deficits in which are not explained by general developmental delays, and point to the pivotal role of early linguistic environment in the development of the neural networks involved in language processing.

A Meta-Analysis of the Association Between Birth Weight and Attention Deficit Hyperactivity Disorder

A large body of work has investigated the association between birth weight and ADHD and has resulted in mixed findings with regard to the direction and magnitude of this association. Despite the vast amount of research on this topic, a comprehensive and systematic quantification of the association between birth weight and ADHD has yet to be undertaken. A meta-analysis of 88 unique studies (N = 4,645,482) was conducted to quantify the overall effect size of birth weight on ADHD symptoms. Several variables were examined as moderators that may contribute to systematic variation in effect sizes. Overall, birth weight was found to have a small, but significant, association with ADHD symptoms such that individuals born at lower birth weights manifested greater symptoms of ADHD (r = -0.15). Sample type, mean birth weight of the sample, geographic region, the informant of ADHD symptoms, ADHD symptom measurement method, and race were all found to contribute significantly to heterogeneity in effect sizes. Notably, several early life risk factors previously found to be associated with both ADHD and birth weight, gestational age and prenatal smoking exposure, were not found to contribute to heterogeneity in effect sizes. The findings of the current analyses align with the growing recognition that early life adversity contributes to neurodevelopmental difficulties, and the findings highlight the importance of a better understanding of the mechanisms underlying the association between early life risk factors and adverse neurodevelopmental sequela, such as that observed in ADHD.

Social touch interacts with infants' learning of auditory patterns

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Infants use intersensory redundancy provided by social touch to learn auditory patterns.

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There is wide variation in the frequency of different patterns of touch from caregivers.

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Less frequent patterns of touch may be more likely to enhance attention and learning.

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The findings suggest that infants track patterns of touch in naturalistic input from caregivers.

Infants’ experiences are defined by the presence of concurrent streams of perceptual information in social environments. Touch from caregivers is an especially pervasive feature of early development. Using three lab experiments and a corpus of naturalistic caregiver-infant interactions, we examined the relevance of touch in supporting infants’ learning of structure in an altogether different modality: audition. In each experiment, infants listened to sequences of sine-wave tones following the same abstract pattern (e.g., ABA or ABB) while receiving time-locked touch sequences from an experimenter that provided either informative or uninformative cues to the pattern (e.g., knee-elbow-knee or knee-elbow-elbow). Results showed that intersensorily redundant touch supported infants’ learning of tone patterns, but learning varied depending on the typicality of touch sequences in infants’ lives. These findings suggest that infants track touch sequences from moment to moment and in aggregate from their caregivers, and use the intersensory redundancy provided by touch to discover patterns in their environment.

Post-adoption depression: Parental classes of depressive symptoms across time

BACKGROUND

Approximately 10-15% of birth mothers and fathers experience postpartum depression, but reports of depressive symptoms in adoptive parents are more variable. Findings from investigators range from 10% to 32%, which may mask the experiences of distinct groups of adoptive parents from pre-to post-placement of a child.

METHODS

We performed latent class growth analysis using the Center for Epidemiologic Studies-Depression scores of 129 primarily heterosexual, adoptive parents (50% females) for three time points: 4-6 weeks pre-placement of the child, 4-6 weeks post-placement, and 5-6 months post-placement. Mixed effects models by parent depressive trajectories were also conducted for three types of variables: interpersonal, psychological symptoms, and life orientation.

RESULTS

Five classes of depressive symptom trajectories were found. The majority of parents (71%) belonged to a class with low levels of depressive symptoms across time. However, two classes of parents were above the threshold for depressive symptoms at placement, and three classes of parents were above the threshold at 6 months post-placement. The majority of interpersonal, psychological symptom, and life orientation variables were significant across classes and by time.

LIMITATIONS

The homogeneity of the sample calls for replication of study findings.

CONCLUSIONS

An explanation for inconsistencies in the range of adoptive parent depressive symptoms may be explained by different subgroups of parents who vary by their trajectory of depressive symptoms before and after placement of the child. Adoption and mental health professionals should be aware that select adoptive parents may struggle pre-and post-placement of a child.

Effects of institutional rearing and foster care on psychopathology at age 12 years in Romania: follow-up of an open, randomised controlled trial

BACKGROUND

Early social deprivation can negatively affect domains of functioning. We examined psychopathology at age 12 years in a cohort of Romanian children who had been abandoned at birth and placed into institutional care, then assigned either to be placed in foster care or to care as usual.

METHODS

We used follow-up data from the Bucharest Early Intervention Project (BEIP), a randomised controlled trial of abandoned children in all six institutions for young children in Bucharest, Romania. In the initial trial, 136 children, enrolled between ages 6-31 months, were randomly assigned to either care as usual or placement in foster care. In this study we followed up these children at age 12 years to assess psychiatric symptoms using the Diagnostic Interview Schedule for Children (4th edition; DISC-IV). We also recruited Romanian children who had never been placed in an institution from paediatric clinics and schools in Bucharest as a comparator group who had never been placed in an institution. The primary outcome measure was symptom counts assessed through DISC-IV scores for three domains of psychopathology: internalising symptoms, externalising symptoms, and attention-deficit hyperactivity disorder (ADHD). We compared mean DISC-IV scores between trial participants and comparators who had never been placed in an institution, and those assigned to care as usual or foster care. Analyses were done by modified intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00747396.

FINDINGS

We followed up 110 children from the BEIP trial between Jan 27, 2011, and April 11, 2014, and 49 children as comparators who had never been placed in an institution. The 110 children who had ever been placed in an institution had higher symptom counts for internalising disorders (mean 0·93 [SD 1·68] vs 0·45 [0·84], difference 0·48 [95% CI 0·14-0·82]; p=0·0127), externalising disorders (2·31 [2·86] vs 0·65 [1·33], difference 1·66 [1·06-2·25]; p<0·0001), and ADHD (4·00 [5·01] vs 0·71 [1·85], difference 3·29 [95% CI 2·39-4·18]; p<0·0001) than did children who had never been placed in an institution. Compared with 55 children randomly assigned to receive care as usual, the 55 children in the foster-care group had fewer externalising symptoms (mean 2·89 [SD 3·00] for care as usual vs 1·73 [2·61] for foster care, difference 1·16 [95% CI 0·11 to 2·22]; p=0·0255), but symptom counts for internalising disorders (mean 1·00 [1·59] for care as usual vs 0·85 [1·78] for foster care, difference 0·15 [-0·35 to 0·65]; p=0·5681) and ADHD (mean 3·76 [4·61] for care as usual vs 4·24 [5·41] for foster care, difference -0·47 [-2·15 to 1·20; p=0·5790) did not differ. In further analyses, symptom scores substantially differed by stability of foster-care placement.

INTERPRETATION

Early foster care slightly reduced the risk of psychopathology in children who had been living in institutions, but long-term stability of foster-care placements is an important predictor of psychopathology in early adolescence.

FUNDING

National Institute of Mental Health and the John D and Catherine T MacArthur Foundation.

A Longitudinal Study of Language and Speech in Children Who Were Internationally Adopted at Different Ages

Purpose

The author followed 56 internationally adopted children during the first 3 years after adoption to determine how and when they reached age-expected language proficiency in Standard American English. The influence of age of adoption was measured, along with the relationship between early and later language and speech outcomes.

Method

Children adopted from Eastern Europe at ages 12 months to 4 years, 11 months, were assessed 5 times across 3 years. Norm-referenced measures of receptive and expressive language and articulation were compared over time. In addition, mean length of utterance (MLU) was measured.

Results

Across all children, receptive language reached age-expected levels more quickly than expressive language. Children adopted at ages 1 and 2 “caught up” more quickly than children adopted at ages 3 and 4. Three years after adoption, there was no difference in test scores across age of adoption groups, and the percentage of children with language or speech delays matched population estimates. MLU was within the average range 3 years after adoption but significantly lower than other language test scores.

Conclusions

Three years after adoption, age of adoption did not influence language or speech outcomes, and most children reached age-expected language levels. Expressive syntax as measured by MLU was an area of relative weakness.

Phonological processing skills of children adopted internationally

PURPOSE

In recent years, large numbers of children have been adopted from abroad into the United States. This has prompted an interest in understanding and improving the developmental outcomes for these children. Although a growing number of studies have investigated the early language development of children who have been adopted internationally, few have focused specifically on the phonological processing development of this group of children, even though it is widely acknowledged that phonological processing skills are important in language and literacy acquisition. The purpose of this study was to examine the phonological processing skills of a group of children who had been adopted from China into the United States.

METHOD

The participants were 45 children who had been adopted from China ( M age at adoption = 13.09 months). The children were assessed between the ages of 6;10 (years;months) and 9;4. Their phonological processing skills, spoken language skills, and reading comprehension skills were assessed using norm-referenced measures.

RESULTS

Overall, the majority of children scored at or above the average ranges across measures of phonological awareness, phonological memory, and rapid naming. The children's reading comprehension scores were moderately to highly correlated with their phonological processing scores, but age at the time of adoption was not highly correlated with phonological processing or reading comprehension.

CONCLUSION

The findings of the current study provide a basis for an optimistic view regarding the later language and literacy development of school-age children who were internationally adopted by the age of 2 years.

Attention and language as mediators of academic outcomes following early psychosocial deprivation

Children adopted from institutions at older ages are at increased risk of persistent attention problems, lower cognition, and academic difficulties. This study examined cognitive and behavior problems as mediators of the association between early psychosocial deprivation and academic functioning. Participants were 8–17-year-old children adopted from psychosocially-depriving Russian institutions after 14 months of age ( n = 34) and before 9 months of age ( n = 39). Children completed a cognitive assessment, while their parents completed questionnaires on child behavior problems and use of learning support services in school. Children adopted after 14 months were found to have significantly lower vocabulary, higher levels of attention problems, and higher rates of using learning support services relative to children adopted before 9 months after controlling for age at assessment. The two groups did not differ significantly in nonverbal reasoning, anxiety, or oppositional behavior. Attention and vocabulary significantly mediated the association of early psychosocial deprivation with the use of learning support services. These findings suggest that interventions targeting attention regulatory and language skills may be beneficial in terms of improving school performance in this population.

Effect of foster care on language learning at eight years: findings from the Bucharest Early Intervention Project

This study reports on language outcomes at eight years from the Bucharest Early Intervention Project, a randomized controlled study of foster care. We previously have shown that children placed in foster care by age two have substantially stronger preschool language outcomes than children placed later and children remaining in institutional care. One hundred and five children participated in the current study, fifty-four originally assigned to foster care and fifty-one to continued institutional care. Even though current placements varied, children originally in foster care had longer sentences and stronger sentence repetition and written word identification. Children placed in foster care by age two had significant advantages in word identification and nonword repetition; children placed by age 1 ; 3 performed equivalently to community peers. The results show the continuing adverse effects of early poor institutional care on later language development and the key importance of age of placement in a more optimal environment.

Home environment: association with hyperactivity/impulsivity in children with ADHD and their non-ADHD siblings

OBJECTIVE

We wished to ascertain if there is an association between symptoms of attention-deficit/hyperactivity disorder (ADHD) and home environment in children with ADHD and non-ADHD siblings, controlling for other environmental measures.

METHODS

96 children with ADHD combined type (ADHD-CT) and their siblings participated in the study. Parent and teacher Conners' rating scales were completed and home environment was assessed using the middle childhood and early adolescent Home Observation for Measurement of the Environment (HOME). ADHD symptoms were assessed for correlation with HOME in children with ADHD-CT and non-ADHD siblings and multiple regression analysis was used to control for gender, socio-economic status, exposure to nicotine, exposure to alcohol in utero, birth weight, gestational age, pregnancy and perinatal risk factors. The presence of oppositional disorders was assessed for association with HOME score in those with ADHD-CT. The multiple regression analysis was repeated controlling for environmental factors and for oppositional disorders in those with ADHD-CT. Oppositional symptoms were assessed for correlation with HOME score in non-ADHD siblings.

RESULTS

Teacher-rated hyperactive/impulsive scores correlated with HOME (r=-0.27, P < 0.01) in children with ADHD-CT. This association remained significant when other environmental factors and oppositional disorders were controlled for. Environmental factors and gender contributed to 30% of the variance of ADHD symptoms in ADHD-CT. Parent-rated hyperactive/impulsive scores also correlated with HOME (r=-0.28, P < 0.05) for non-ADHD siblings. An association between HOME and diagnosis of oppositional defiant disorder or conduct disorder was found for children with ADHD-CT and between HOME and oppositional symptoms in non-ADHD siblings.

CONCLUSIONS

The home environment has a small but significant association with hyperactive/impulsive symptoms in children with ADHD-CT and non-ADHD siblings. This association remained when other environmental factors were taken into account. Oppositional symptoms are associated with home environment in ADHD-CT and in non-ADHD siblings.

ADHD-like symptoms and attachment in internationally adopted children

Internationally adopted children seem to be more likely to show ADHD-like symptoms than non-adopted children. The aims of this study were to explore the existence of ADHD-like symptoms and/or diagnosis in a sample of internationally adopted children depending on their country of origin and to describe the links that may exist between the display of these symptoms and observed narrative-based attachment patterns. A Catalan sample of 58 adopted children aged 7-8 (24 from Eastern Europe, 23 from China, and 11 from Ethiopia) was assessed with the Behavioral Assessment System for Children to identify ADHD-like symptoms, and the Friends and Family Interview to identify children's' attachment patterns. Results indicated that children adopted from Eastern Europe showed a trend toward more hyperactivity and significantly more attention problems than girls adopted from China. Children with a secure attachment showed significantly less attention problems and a trend toward less hyperactivity. More studies focusing on the etiology and treatment of these symptoms in adopted children are needed.

Nursing care of the adoption triad

PURPOSE

This study describes the practice settings and interventions of nurses who care for members of the adoption triad (AT; birth parents, adoptive parents, child).

DESIGN AND METHODS

A 28-item, descriptive, cross-sectional survey was used.

FINDINGS

Ninety-seven (97) nurses provided complete (65) or partial (32) responses. Most frequently reported practice settings were labor, delivery or postpartum unit, and pediatrics. Assessed needs varied by AT members. However, interventions for all members of the triad included emotional support and therapeutic communication.

PRACTICE IMPLICATIONS

The unique placement of advanced practice nurses in various clinical settings allows for contact with members of the AT in vulnerable and crisis periods.

The Effects of Early Neglect on Cognitive, Language, and Behavioral Functioning in Childhood

OBJECTIVES

Few studies have explored the impact of different types of neglect on children's development. Measures of cognition, language, behavior, and parenting stress were used to explore differences between children experiencing various forms of neglect, as well as to compare children with and without a history of early neglect.

METHODS

Children, ages 3 to 10 years with a history of familial neglect (USN), were compared to children with a history of institutional rearing (IA) and children without a history of neglect using the Differential Abilities Scale, Test of Early Language Development, Child Behavior Checklist, and Parenting Stress Index. Factors predicting child functioning were also explored.

RESULTS

Compared with youth that were not neglected, children with a history of USN and IA demonstrated lower cognitive and language scores and more behavioral problems. Both internalizing and externalizing behavior problems were most common in the USN group. Externalizing behavior problems predicted parenting stress. Higher IQ could be predicted by language scores and an absence of externalizing behavior problems. When comparing the two neglect groups, shorter time spent in a stable environment, lower scores on language skills, and the presence of externalizing behavior predicted lower IQ.

CONCLUSION

These findings emphasize the importance of early stable, permanent placement of children who have been in neglectful and pre-adoptive international settings. While an enriching environment may promote resilience, children who have experienced early neglect are vulnerable to cognitive, language and behavioral deficits and neurodevelopmental and behavioral evaluations are required to identify those in need of intervention.

How well do children who are internationally adopted acquire language? A meta-analysis

PURPOSE

In this article, the authors present the results of a systematic and meta-analytic examination of the language outcomes of children who are internationally adopted. The study examined the questions of whether the early life experiences of children who are internationally adopted and the language switch that occurs after adoption hinder the acquisition of language skills.

METHOD

The authors selected available studies on the language acquisition of internationally adopted children using search strategies from both a comprehensive set of databases and manual searching of selected studies. Study eligibility criteria included (a) participants clearly identified as being internationally adopted, (b) measurable language outcomes were reported, (c) a control group or normative measure was used in the design of the study, and (d) effect size was reported, or data were provided to calculate effect size.

RESULTS

The meta-analysis found that as a group, the children expressed great variability in their language skills. Overall, they were more likely to have poorer language outcomes than comparison children, but several moderating variables were found.

CONCLUSIONS

The results of the meta-analysis have direct clinical application regarding the assessment and treatment of language skills of internationally adopted children. The study also has implications for future studies of the language development of internationally adopted children.

Behavioral and emotional symptoms of post-institutionalized children in middle childhood

BACKGROUND

Experience in institutional/orphanage care has been linked to increased mental health problems. Research suggests that children adopted from institutions experience specific difficulties related to inattention/overactivity. Evidence of internalizing and conduct problems relative to non-adopted peers has been found in early childhood and early adolescence, but problems may not differ from other adopted children. This study clarifies the understanding of behavioral and emotional symptoms of post-institutionalized (PI) children during middle childhood.

METHODS

Eight- to eleven-year-old PI children (n=68) and two comparison groups, children internationally adopted from foster care (n=74) and non-adopted children (n=76), and their parents completed the MacArthur Health and Behavior Questionnaire related to attention-deficit/hyperactivity disorder (ADHD), externalizing, and internalizing symptoms. Group means for symptom level and number of children with symptoms above clinical cutoffs were compared.

RESULTS

PI children displayed an increased level of ADHD symptoms per parent report. PI child and parent report indicated a higher number of PI children above clinical ADHD cutoff. Both groups of internationally adopted (IA) children had higher levels of externalizing symptoms relative to non-adopted children, with parent report indicating higher numbers of IA children above the externalizing clinical threshold. Informants differed in their report of internalizing symptoms. Parents indicated that both IA groups displayed increased internalizing symptom levels and greater numbers above clinical threshold; however, children reported this to be true only for the PI group.

CONCLUSIONS

PI children differ from non-adopted peers across symptom domains in middle childhood. Whether these concerns were more broadly associated with international adoption rather than institutional care depended on symptom domain and informant. An understanding of this variability may be beneficial for treatment and intervention.

Developmental and behavioral performance of internationally adopted preschoolers: a pilot study

Most international adoptees (IA) have rapid catch-up of the delays common at arrival. However, it is not known whether development at arrival predicts later abilities or school readiness. Therefore, we comprehensively evaluated language, fine motor, visual reception (VR), executive function (EF), attention (ATT), and sensory skills (SS) in IA preschoolers. We hypothesized that pre-adoptive risk factors, development at arrival, and the post-adoptive environment (time in day care) would predict developmental and behavioral outcomes and school readiness. 37 IA (12M:25F), currently age 4-5 years and previously seen in our clinic (mean arrival age 12 months), were evaluated with standardized tests of development, language, EF, ATT, and SS, along with demographic information, parent interview, and review of arrival clinic records. Fine motor and VR skills at arrival ranged from average to very below average. At followup, most IA were average or above average in fine motor, VR, and language skills, but many had concerning scores for ATT (42%), EF (11%) and SS (48%). Arrival expressive language T scores (Mullen) predicted follow-up scores for expressive language (PLS-4, r = .44, p = .005). Arrival fine motor scores (Mullen) correlated with follow-up auditory comprehension scores (PLS-4, r = .47, p = .002) and inversely with inattention scores (Conners', r = -.48, p = .003). Arrival visual reception scores correlated inversely with global measures of attention (Conners' opposition r = -.45, p = .005, ADHD scores r = -.49, p = .002, and to a lesser extent hyperactivity r = -.35, p = .03). Age at arrival was a very strong predictor of many of the outcome measures tested, including language performance, attention regulation, executive function, and sensory processing. Children who spent more time in daycare had significantly more difficulty with emotional control (p = .005). Although IA have good catch-up in specific areas of development, difficulties with ATT regulation, EF, and sensory processing may increase the risk of later school problems.